History Taking Skills
History Taking Skills
Recent years have seen a shift in the perception of communication skills from being considered subjective personal traits, to an objective, evidence-based curriculum of skills and techniques. This development was founded on the recognition that core communication skills are identifiable, can be taught, and form the basis of the majority of professional encounters. The core skills required for the patient interview in the MRCP (PACES) examination can be broadly divided into three areas: content skills, process skills, and perceptual skills. The content of the medical interview refers to the information the candidate is attempting to gather, or to give, during the course of the interview. The detail of this content is covered in the subsequent case histories of this book. However, the ability of the candidate to communicate or acquire this content depends largely on the process of the interview, and their perceptual skills. The process of the interview refers to the manner in which the candidate communicates with the patient. Although the candidate’s agenda may be to establish the content of the interview, this will not be successful unless the patient’s agenda in considered. In Stations 2 and 4 of the PACES examination, the candidate is provided with clear written instructions (such as a GP letter), followed by 14 minutes for patient interaction. The candidate then has 1 minute for reflection, followed by 5 minutes of discussion with the examiners. Despite the limited time available in the PACES Stations 2 and 4, the examiners will expect the candidate to develop rapport, show empahty, appropriately use silencce during the interview, and interpret non-verbal cues. Indeed, these processes are the key to obtaining the content of the interview, not just for the examination but also for clinical practice. Perceptual skills refer to the candidate’s decision making, problem solving, and clinical reasoning skills. These are complex, higher-order skills, which reflect the individual’s attitudes, beliefs, and self-perception. Indeed, if the content of the interview reflects the candidate’s ‘knowledge’, and the process of the interview is a reflection of ‘technique’, then these perceptual skills are a demonstration of appropriate ‘behaviour’ or ‘performance’.
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